Monthly Archives: May 2015

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the “#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.

We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?

The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.

Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.

Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.

While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.

This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health.

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear.

– The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium. All in all, those laboratory markers make up the syndrome of starvation. Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain. This can cause brain injury and even death. In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.

Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated. Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury. It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.

It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia. I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day. It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors. Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch. EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes. A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level. Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.

Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice. A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels. One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged. They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns. The Denmark study found a 67% higher risk of autism in jaundiced newborns.

That being said, I don’t want to worry every mom whose child had jaundice. Not every jaundiced newborn has a level above 15. Also, not every child who develops a level above 15 will develop autism. Autism is still a genetic disease. I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding. I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital. No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present. We were told to count the diapers but how wet is a wet diaper?

My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day. I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too. I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?” Three-and-a-half years later, I found out what his brain injury looked like.

What I saw with my own physician- and mother-eyes was the slow torture of a newborn child. Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony. No textbook, lactation consultant or physician will ever convince me otherwise. To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production. We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it. THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments. Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014. I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism. I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic. I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community. So much so that no part of it as outlined by the lactation community has been challenged by the physician community. We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding. Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm. I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula. If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time. In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all. According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C. Wet nurses were often employed to feed newborns whose mother could not lactate. There are modern day cultures where babies are breastfed by a community of mothers, not just one mother. Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.” These moms probably just call it “feeding.” Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day. It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital. This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor. However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers. So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula. Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community. I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community. It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns. This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more. I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?” I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care. This teaching has been accepted for decades now. To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is. I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days. A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL. I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day . A 7 lb child would need 19.6 oz of milk in one day. I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz. They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity. For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines? There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run. We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied. While babies’ bodies can endure days of underfeeding, their brains cannot. That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.” Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide. People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding. I am absolutely AGAINST starving a child to achieve it. I have received quiet support from several of my peers, but mostly silence for the majority. I believe colleagues who are silent are incredulous or shocked or afraid. I can’t truly know. I can understand it because I am a physician and we are taught to stick close to the pack. I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm. There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma. I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page?

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms. However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle. These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child. I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula! It’s crazy. What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months. No response from the organization that is supposed to protect our newborns. So I decided to inform the public on my own. At first I was afraid. Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons. People on the internet can act with cruelty because they don’t have to suffer any consequences. I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm. Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss. I haven’t received too many challenges from physicians though, interestingly enough. At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum. Mom should also be instructed on listening for swallows to detect transfer of milk.

2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room. The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed. If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice. Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad. These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in. A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production. Supplementation should be a choice and be accepted and supported by the medical community as a patient right. A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help. Parents need sleep and they don’t get much in the postpartum period. Additionally, experienced parents know the look and sound of a child who is hungry or in distress. The child’s wishes should be honored. I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue. Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate. This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast. We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns? What are we doing to our mothers? It breaks my heart every day the things mothers have told me about inadvertently starving their newborns. They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child. But they were told breastfeeding is always enough as long as your child is producing diapers. What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did. I was in the hospital for a whole 48 hours while my son was receiving nothing for me! Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies. These mothers deserve better.

When I started the Fearless Formula Feeder back in 2009, no one was really talking about women who didn’t breastfeed. There simply wasn’t a narrative on this topic yet, other than a few rogue posts by brave (and beloved) parenting bloggers which were always followed by comments like “don’t worry, you tried your best!” and “Every drop counts! At least you did everything you could to give him the best.” This was one of my main reasons for starting the blog – because, as nice as it was to feel like people were patting women like me on the back for going through hell, I didn’t think women should HAVE to go through hell. And not just for the usual reasons people recite, like how we shouldn’t care what others think, and the importance of bodily autonomy, and blah blah blah, but because it really is okay to choose formula.

But the problem was, the women who seemed to need the most support, who were in the midst of a unique trauma that no one was recognizing, were those who had gone through hell. So I had to stand up for them, first. It was like advocate triage – you deal with the worst traumas while patching up the ones who can wait a little while.

I fear, though, that those people are still waiting, sitting in some virtual, sterile waiting room with bad elevator music playing on an endless loop, staring at the women sitting next to them and wondering if they really belong here. If they tried hard enough, if they have a reason to need support. If they still qualified as good moms, even if they quit breastfeeding after a day, an hour, or never latched a baby to a breast.

Julie S. is in that waiting room. In fact, her story submission got lost in my inbox, and I only unearthed it today (thank god, because it’s amazing). So she’s been waiting in more ways than one.

Julie– and all the others who’ve been comparing, wondering, worrying: I’ve been the woman in hell, and the one in the waiting room. I barely “tried” to breastfed my second child. And that’s okay. It has to be okay. I want you to feel proud that you listened to your gut, that – as Julie so perfectly puts it – you “made a decision”. There is so much power in that. When I was the woman in hell, I needed to see that there were those brave enough to make that choice and own it. It gave me the strength to break out of my self-inflicted prison and do what was needed to survive, to realize that it’s motherhood, not martyrhood.

So this weekend, after you read Julie’s story, do me a favor. Help me form a new goal for FFF: a movement where the women in the waiting room and the women in hell join hands, bust through the doors, and demand to be seen, demand to be heard, as one strong, cohesive, unit. Because the cold, hard truth is this: until the reasons don’t matter, the reasons are going to matter. Until it’s okay to not breastfeed, it’s not going to be okay not to breastfeed. And it is okay. It is.

Happy Friday, fearless ones,

The FFF

***

Trying My Best? My Journey to Formula

by Julie S.

***

Maybe I didn’t “try the best I could” and maybe that’s okay.

Outside of about 5 weeks of some breast milk, my now 3-year-old son was exclusively formula fed, and now my newborn daughter is as well. I have an enormous amount of guilt, doubt, and insecurity surrounding the fact that I did not breastfeed my children for very long. I used to say I wasn’t “able” to breastfeed my son, but this was not really true. It was difficult, and there were obstacles that made it very challenging, but I could have pushed forward, plugged away, tapped out all of my energy and resources, and probably made it past those first seemingly impossible weeks. The same could be said for my experience with my daughter, although the challenges and the journey were different.

I read the Fearless Formula Feeder entries with a certain hunger to find absolution. “Yes, that was me!” I tell myself. But oftentimes, I read heartbreaking stories of “I did everything I could, to the point of my own exhaustion and sacrificing my physical and mental well-being, and still didn’t have enough milk”, or the baby still wouldn’t latch, etc. And I think to myself, “You did what was right! For you and your baby!”

But I suppose I don’t give myself the same slack, and maybe it’s because, in my estimation at least, I never “did the best I could” to the detriment of all else, and still have to stop breastfeeding.

When I was pregnant with my son, it never occurred to me that I wouldn’t breastfeed. I didn’t really know much about the existence of formula. I didn’t even have a bottle in the house as per the recommendation of my lactivist friend who had nursed her three sons until age four. I didn’t read a book or take a class because I just thought, like many women do, that nursing came naturally.

Well, I learned real quickly that very few of my assumptions about breastfeeding were true. In the hospital, I was told that my “milk hadn’t come in yet” (later to learn that almost no woman’s milk would have come in so soon) and when my son was not latching successfully at the hospital, they were already syringe feeding him formula and sticking me on a pump by the end of his first day on Earth. By day three when I was being sent home, the lactation consultant sent me with bottles of formula. A variety of lactation consultants and nurses all had their own advice about how to get my son to properly latch, but all of them just left me confused and frustrated. I therefore went home confused and frustrated. And without a good plan.

The day my milk came in, I cried. I called my husband and mother into the room and showed them the huge wet spot on my shirt. What a relief. But by then, we had been supplementing with formula for almost a week, allowing me to actually get some sleep while my mother and husband and I took turns giving my son a bottle every two hours. My son eventually latched and seemed to be feeding okay, although in my mind he seemed like the slowest feeder in the universe. By then, I knew the “temptation” of formula and bottles. I knew the relief they provided me. I knew that I really liked not having my son chained to my body nearly 24/7.

That was a turning point for me. At that moment when my milk came in, I could have ramped up my efforts, called in a lactation consultant, gone to La Leche League meetings, and pumped like a maniac, and brought my supply and nursing skills to where they needed to be. But I didn’t. It was just easier, and obviously more desirable to me, to wean him from his already very rare breastfeedings.

When I was pregnant with my daughter, I asked myself what I was going to do this time around (and many others asked me this too). By then I was a pretty well-established formula “advocate” in my mommy circles, but also didn’t hide the guilt that continued to plague me surrounding this issue. I knew I wanted to at least try to breastfeed again, but I was scared. What if I couldn’t prove to myself that I could do it this time? What if I was just never going to be one of “those” women who made breastfeeding look so easy and gratifying? Or, worse yet, one of those women who put everything on the line to make it work? What if I was just too lazy? On the flip side, would I be a huge hypocrite if I ended up exclusively breastfeeding, given all of my talk about formula advocacy?

My daughter was born and they asked if I wanted to nurse. I said yes. They gave her to me and she latched on immediately, like a pro, and sucked away for a good hour. I thought to myself that this was like magic, and I was blessed with an easy go around this time. That night, however, it didn’t seem so easy when she would latch on and suck like a maniac every five seconds, if she even took a break. My nipples felt like needles were being stuck into them and one of them was already cracked and bleeding. I dreaded every feeding, but pushed through somehow. The next day, her magic latch had suddenly vanished. She seemed to possibly have some sort of tongue tie, and the only way she would latch was with a nipple shield. But it was going okay enough, and my milk miraculously came in full force on day three as I was waiting to be discharged. My baby girl sucked like never before, and I realized she was satisfied to finally have some real milk coming out.

I was pretty happy with myself that I had made it home without a bottle or a drop of formula in my baby. I rented a hospital grade pump and took home some nipple shields. I had also formed some semblance of a plan with one of the lactation consultants (I did, however, ask for some free formula just in case. I was well aware how expensive it was!)

Nursing a newborn exclusively was new to me. I didn’t realize just how constant it was. I started to feel trapped, to feel chained to the house and to my baby, especially since I had never felt comfortable nursing in public but in particular not when it felt like I needed an army of hands and pillows and nipple shields in order to feed her. The nights were the toughest. The second night home, I just couldn’t latch her on anymore. My nipples were so raw, she was still fussing a lot at the breast, and I was just too tired. So I opened a bottle of ready to feed formula and gave it to her. I felt like a failure, but tried to talk myself out of that feeling. I was starting to wake up in a panic and my anxiety disorder was rearing its ugly head again. I asked for advice from others: Could I just give one bottle at night and have it still be okay? What if I pumped extra during the day? I just couldn’t bear to do all of those night feedings by myself with my body alone.

Days passed and I started giving more and more bottles. I wanted to get out and feel free. I wanted to go do things alone and be able to leave my baby home with my husband or another family member so I could breathe for a while. The bottles began to very obviously affect her desire and ability to properly nurse at the breast, and my motivation faded. I hired a lactation consultant but it didn’t remove the feeling of being trapped. Swiftly, I sank into a depression. I dreaded getting up to care for her. I loved her, but the anxiety around feeding her made it even worse.

I saw my psychiatrist who was very concerned about me. She wanted me to go back on a medication I had taken pre-pregnancy, one that was incompatible with nursing. She said she preferred I wean. So I did. I didn’t breastfeed again after that appointment with her.

I went on my full medication therapy and pulled out of my depression and anxiety fairly rapidly. My husband and mother both noticed how much better I seemed to be doing and feeling. I had had a rough pregnancy emotionally and this was the happiest they’d seen me in months. My excruciating incessant fighting with my husband decreased significantly.

But, there I was. I had done it again. I had stopped nursing and my baby was barely 3 weeks old. Those three weeks had felt never-ending, but it was an even shorter time than I had nursed my son. I talked to myself a lot, telling myself that I hadn’t failed. Telling myself that some women are just not cut out for it. Telling myself that Mommy’s health and sanity came first. And most of me believed it. Even with the “permission” of my psychiatrist and my pediatrician, who gave similar advice about my decision, I felt like I was just not sacrificing enough for my child.

This was a few weeks ago. My baby is now fully on formula and I am mostly happy with this. I am sad about stopping nursing and do miss that feeling of closeness with her. I don’t miss the full breasts, the bleeding nipples, and the limiting nature of it all. I have come to terms with it for the most part, but a nagging feeling still remains: I didn’t really do my best, did I? I tried, but not an old college try, right? I put in effort, but not enough. I sacrificed, but not like the best moms do. I didn’t fail; I made a decision. I didn’t give up; I decided to stop. I think of all those women who have “real” reasons: Low supply, cancer, major medical problems, etc. What was my excuse? Am I really just lazy, as I had feared?

I continue to struggle with this. I know I am a good mother to my beautiful, healthy children (who are both good sleepers—must be the formula! 😉 ). I know that I feel a million times better and my marriage is starting to get back to where it should be. I know all of this in my head. But, in my heart, I still doubt. I still doubt.

I am writing this piece in attempt to write my peace. I told myself that I would put my story out there, and then I would let it go. Because we all have something we wish we could have done better, but as moms we need to accept this and move on. So here I go: I am moving on.

When you’ve been on the receiving end of judgment, it can be uncomfortable to admit to yourself that you’ve judged others in the past.

Feeling some inner judgment is normal and healthy. The problems happens when that inner judgment renders us unable to listen, or to consider that there may be a larger story, or make character assumptions based on one single action. The problems happens when we use our own life experience, our own reality, and foist it onto others. The problems happen when we don’t grow, when we don’t own up to our judgment, and address it, and conquer it.

Brianna’s story is a perfect example of how judging ourselves is part and parcel of judging others. Once we can release ourselves of one, the other will follow.

Happy Friday, fearless ones,

The FFF

***

Brianna’s Story

When I became pregnant for the third time there were things I knew. I knew that my blood pressure would likely get high around my 37th week. I knew there was a chance I would not get the natural/out of hospital birth I had longed for with my other two children, and I knew I would breastfeed. After all, I had breasted my second baby for two years. I loved nursing him. Some women say they feel special or beautiful when they’re pregnant. I never felt that way, but I did feel beautiful when I was nursing. I longed to nurse again, and I felt this pregnancy, my last pregnancy, was my chance to do it all the “right” way from the start.

Despite the fact that I had been running 18 miles a week prior to getting pregnant, and despite my borderline obsessive reoccupation with maintaining a healthy diet, my blood pressure started climbing around 37 weeks just as it had in my two previous pregnancies. For the first time, I made it to 40 weeks gestation and I was grateful that my body had allowed my baby to reach full term. At my 40 week appointment my midwife swept my membranes and told me that if I wanted to birth at the birth center I needed to have the baby sooner rather than later. I went into labor the next morning and my third baby, and my only daughter, was born 4 hours later. She nursed immediately just as I knew she would.

During labor my blood pressure had risen to 150/90. That is the threshold at which you are considered hypertensive. Since I was only there for 40 minutes before she was in my arms there was no time for a transfer. Immediately following her birth my blood pressure fell as it had after the births of my first two babies. Seven hours after she was born we were on our way home.

Nursing was going fine, although I was a little concerned that it took over 72 hours for my milk to come in. Over the course of those three days my daughter had lost nearly a pound. When a nurse from the birth center came for my home visit she seemed a little surprised at my blood pressure reading, but not enough to be alarmed. I made an appointment with a lactation consultant because I was concerned about some latching pain and the fact that my milk seemed slow to arrive. That afternoon my milk finally came in and I breathed a sigh of relief.

We went to the appointment with the lactation consultant the next day, and though I was not as engorged as I expected to be, my daughter had transferred a little over an ounce and half during the feeding. I left feeling relieved, and a little silly that I had been so nervous.

A few days later we made a trip to the pediatrician for a weigh in. My little girl was gaining about an ounce a day and she was steadily climbing back up to her birth weight. On the way home I asked my husband to stop at the nearby drugstore so I could check my blood pressure. I wanted to know for certain that it was going down. I was shocked when the reading came back 160/104. I called my midwife who told me to have it rechecked. If it came back higher than 150/90 I was to go to the ER. She told me that though it was rare, women could become preeclamptic postpartum.

I sat at the Minute Clinic waiting to be seen in a state of shock. Would I be admitted? Would I be allowed to keep my breastfeeding baby with me? My blood pressure was rechecked and I resigned myself to the fact that I would be making a trip to the ER that night. I called my midwife back to let her know what was happening. I cried at the thought of being separated from my 5 day old baby, and I asked if they would let me keep her with me but she didn’t know. As a precaution we stopped home on the way and picked up my pump just in case.

All blood and urine tests at the ER came back fine, but my blood pressure remained high. I was able to keep my daughter with me the whole time, which was a huge relief. I was eventually given a prescription for a calcium channel blocker with instructions to see my family doctor on Monday. We left the ER and I began furiously Googling the medication that had just been prescribed to me. At the ER they had said it wasn’t contraindicated for breastfeeding, but what I was finding on the internet, including statements from the drug manufacturer, was not reassuring. I started to cry. I didn’t want my tiny baby to drink milk with medication in it, but I knew I had to take it.

I took the medication before bed that night and woke up the next morning feeling that something was not right with my milk supply. By this time, what had begun as preoccupation and some worry, was beginning to spiral into postpartum depression and panic. The panic came in waves at first. A few times a day I would become preoccupied and worried that I wasn’t producing enough milk, or that my milk was somehow harming my baby because of the medication that was in it. When I wasn’t worrying about those things I was afraid I was going to have a heart attack or stroke. I had no choice but to take the medicine, but I felt it was jeopardizing my breastfeeding relationship.

A few days later we made the trek back to the pediatrician for another weigh in. I was heartbroken to learn that since I had begun taking the medication 4 days earlier my daughter had only gained an ounce. I left with instructions to pump after feedings and to supplement with my milk or formula. I began taking my blood pressure multiple times a day with the hope that it would go down and my doctor would tell me I could go off the medication. It stayed dangerously high. I woke up every morning resolving not to take the medication, but by mid-afternoon I would start fearing that I was going to die, so I’d break down and take it. Even with pumping and supplementing, my tiny daughter was not back up to her birth weight 2.5 weeks after her birth.

The panic that I had been experiencing in waves eventually stopped subsiding. I woke up every morning terrified and shaking. It was like waking up from a nightmare. My husband had to hold me every morning so that I could calm down. I stopped eating. I was terrified of being alone with my children and could not be in my house. I went to my mother’s house every day because I was unable to care for myself or my children. My mom had to hold my hand in public to keep me calm. I felt strangely disconnected from and scared of my children and I cried constantly. At the supermarket a stranger casually remarked at how small my baby was and I burst into tears. I felt unbearable guilt that I wasn’t making enough milk and I believed that the milk I was giving my baby was tainted. I knew I was quite literally losing my mind. It sometimes felt like the small, rational part of my brain that remained was watching the rest of me fall to pieces. I knew I needed medication, but if I couldn’t bear to nurse her on one medication and remain sane how was I going to be able to do it on two?

I made an appointment with my primary care doctor in an attempt to convince him that I could go off the medication. My blood pressure was still dangerously high and as I sat there crying he told me I would need to be on it for 6 months. I was distraught. I knew I wouldn’t be able to deal with what I was feeling for 6 months. I broke down and asked for an antidepressant knowing full well that if I took it that would be the end of nursing for me. It would take a while for me to feel well again and I knew I couldn’t bear the intrusive, paranoid fears I was experiencing about nursing on medication until then.

I filled the prescription for the antidepressant but didn’t immediately take it. That night my mother-in-law came for a visit. I sat motionless at the table while my family ate, unable to muster the willpower to nourish myself. I had gained 40 lbs. in my pregnancy and by 3 weeks postpartum I had lost 30 of those pounds. As I write this I am 3 months postpartum and my mother-in-law still wells up with tears when we talk about how I looked that night.

Later that evening, exhausted by my emotional state, I fell asleep on my husband’s lap on the couch. I woke up the next morning, shaking and terrified as always, but was still unsure if I would take the antidepressant. After dropping my older son off at school, my younger son, my baby, and I sat in the parking lot of a local convenience store. I reached into my glove compartment and pulled out the antidepressant. I took one of the pills out and placed it in my mouth, but didn’t swallow it. I sat like this, with the bitter pill dissolving on my tongue, willing myself to do what I knew I needed to do in order to get my life together. I finally swallowed it and silently said goodbye to my dreams of breastfeeding my last baby.

Roughly 12 hours after taking the first dose of my antidepressant I experienced my first wave of feeling like a capable mother. It came on suddenly and overtook me just as the waves of panic once had. I was talking to my mom when it happened and I told her I thought the medication might be working. I asked her if she could tell and she said my voice and face had actually changed in that moment. I started to experience hunger, something that I couldn’t remember feeling in nearly a week. Temporarily buoyed by feeling centered again I called the MotherRisk hotline to inquire about nursing on the antidepressant and blood pressure medication. The woman I spoke to indicated that the antidepressant was likely safe, and although the blood pressure medication was slightly less safe, it was not contraindicated. I decided to try to nurse my baby to see how I felt. I wanted to try to continue. Initially, I felt ok about it, but when we all piled into the car to head home I suddenly felt the panic returning. I turned to my husband with a very serious look on my face and told him I was feeling panicky again and that I didn’t feel like I could nurse her without the gnawing anxiety returning. Intellectually I knew that she would likely be fine if I continued to nurse her, but the overwhelming sensations coming from my body could not be ignored.

The panic I experienced upon waking didn’t subside for weeks, and though mornings continued to remain tough for me, I slowly started to get better. The panic and depression I had been experiencing while nursing began to dissolve, but were replaced with incredible guilt and embarrassment. I had been such a devoted breastfeeding mother to my second child after “failing” to nurse my first child due to PPD and lack of awareness. Between my first and second pregnancies I learned everything I could about breastfeeding, surrounded myself with breastfeeding women, and tried to correct all the things that I believed had caused me to “fail” the first time. For 4 years I had been a vocal and passionate supporter of breastfeeding, and I was going to have to admit publicly that I had “failed” again. The thought of bottle-feeding my daughter in public filled me with dread.

It was the dread that lead me to a painful opportunity for personal growth.

I was forced, in this moment; to admit to myself that I had once been judgmental of the women I had seen bottle-feeding their children. If I had been asked prior to this experience if I judged women for bottle-feeding I would have said no. After all I had bottle-fed my first child. It would have been a lie. I felt judgment because I had been judgmental, and that was a painful, but ultimately freeing truth to acknowledge.

Ironically, it took the birth of my only daughter to teach me how to support other women without judgment. It was with pure arrogance that I had once thought that with more education and support all women should or could breastfeed the way I did with my second child. The truth is I know nothing for certain. About myself or anyone else. Instead of looking at a woman feeding her baby with a bottle and thinking she should be breastfeeding I am keenly aware that she may have experienced something worse than I can possibly imagine which lead her to this choice. Whatever her reasons for not breastfeeding may be, they are none of my business.

It was only after I stopped nursing that I was able to fully bond to my daughter. I maintain the kind of relationship with her that breastfeeding would have fostered by wearing her often, holding her often, talking to her, playing with her, putting her to bed at night and being the first one to see her in the morning. None of these things are dependent on the way I chose to feed her, but have gone a long way to heal the disconnectedness I experienced after her birth. I’d heard the message that a healthy, happy mother makes a healthy, happy baby, but part of me discredited it. I still truly believed that self-sacrifice, nearly at any cost, was what mothering demanded. I no longer believe that to be true. When we take care of ourselves our children thrive. I see it now in every gleeful smile, in all the chubby folds of my daughter’s beautiful, growing body, and in the way she lights up when she sees me at the start of our day. I see it in the way my oldest son asked me tentatively one day after I started the medication if I was happy. When I said yes, he told me that he could see it in my face.

It was my love for my daughter, though distorted through the lens of depression that caused me to stop nursing. Someday, if she chooses to have children herself, I will look into her weary eyes and tell her this story. Perhaps she will breastfeed. Perhaps she won’t, and that’s more than ok. It’s best.

As you’re all aware (provided you haven’t DVR-d past those jewelry commercials and avoided the card and party aisle at the drugstore), this Sunday is Mother’s Day.

Beyond the usual Hallmark cheese, our new digital age has ushered in a new wave of delights in honor of the occasion: viral videos showing (in a imperceptibly condescending manner) just how hard this mothering gig is; flowery status updates about the importance of motherhood clogging up your news feed; and, come Sunday, an onslaught of staged “Mother’s Day 2015” photos from your friends, perpetuating the myth that all of us are perfectly coiffed, perfectly happy, perfectly perfect moms who are perfectly adored by our children.

Don’t get me wrong – I like it. My kids make me great gifts in school (like the card Fearlette brought home yesterday, which included her guess of my approximate age as “72” and my height as 2 feet, which is totally accurate). Sometimes, I get to sleep until 8:30, which is heaven. I’m not kicking this holiday out of bed.

I just wish that, instead of overpriced flowers and jewelry, generic sentiments and hero worship, we could get what we really need for Mother’s Day.

Like subsidized maternity and paternity/partner leave, because having a newborn is hard, and being all alone with what amounts to a tiny terrorist (or several terrorists, if you have multiple children) is easier when there’s two adults around. Safety in numbers and all that.

Like a prenatal experience that actually prepares you for taking care of a baby, and doesn’t pretend that every woman has a supportive partner, money to burn, and the desire to breastfeed, birth naturally, and quit her job.

Like a hospital experience that respects your wishes to breastfeed or not to breastfeed, and is mother-friendly as well as baby-friendly, because pushing a baby out of your vagina/ having major surgery is kind of hard work. Not that being born isn’t hard, too, but why can’t we be friendly to both mom and baby? And while we’re at it, friendly to partner-parents, too?

Like a world that accepts that the term “good mother” doesn’t have one definition, and that what works for me and my child might not work for you and yours, and that’s a beautiful thing, because we aren’t robots. (At least not yet.)

Like more inclusivity for adoptive mothers, on this holiday and every day, because growing a child in your body isn’t a prerequisite for the title of “Mother”, nor has it ever been, or ever will be.

Like an Internet that gives us all the good stuff – support, information at our fingertips, a way to connect with the world even if we’re housebound, stuck inside with a immuno-compromised preemie in the dead of winter/having a hard time getting out of our pajamas, but leaves the bad stuff behind, like the judgment and smug pseudo-science and mommy-board trolls and my-way-or-highway bullies.

Like safe, clean, food-secure environments for all women and their children, because it’s so easy to forget that as we fight about feeding our babies, some women can’t feed themselves.

Like partners and/or family members and/or friends who are always there for us, and who have been given the tools to support us while we are breastfeeding but also respect when we decide not to.

Like care providers who acknowledge that postpartum depression and anxiety are real, and prevalent, and treatable, and worth prioritizing over general recommendations from the World Health Organization or the AAP.

Like accessible and judgment-free lactation assistance and bottle-feeding assistance, without having to take out a second mortgage to afford the help.

Like the realization that mothering extends beyond the first year, and that we will face all sorts of challenges as our kids grow which will give us an opportunity to be amazing or screw it up, and thank god for that, because too many parents have that ripped away from them, and we are so, so lucky to be able to screw our kids up for as long as we can.

Like health recommendation messages that are backed up by hard science but also humanized, because they are being delivered to a group of people who just got hit with a Mack truck of change and upheaval, and who are living in constant fear of all those .001% risks that you make sound like very real possibilities.

Like a magic solution to all the mother-on-mother competition and turmoil, because while it’s human to judge and question, our utterly inhuman method of communication has taken it to an insidiously harmful place where we hide behind screens and levy our judgments without ever having to endure the impact this has on those being judged. The jury of our peers is the least just.

Like a promise that we will stop pressuring women into using their bodies certain ways; assessing their strength and power by their bodily functions; and forcing them into narrow categories based on how they birth, feed, diaper, and transport their babies.